Bill CPT 99173 for eyesight screening of both eyes with a test that employs graduated visual acuity stimuli to estimate the visual acuity quantitatively.
1. What Is CPT Code 99173?
CPT 99173 covers an eyesight procedure for both of the patient’s eyes. A pediatrician uses letters of varying sizes on a standard chart (for example, Snellen’s chart) and asks a patient to read them. The chart needs to be positioned 20 feet from the pediatric patient.
The CPT book describes CPT code 99173 as follows: “Screening test of visual acuity, quantitative, bilateral.”
The 99173 CPT code procedure starts with the provider vertically placing the visual testing chart on a wall or stand. Then, the provider explains the procedure to the patient and asks them to move 20 feet away from the chart.
Next, the patient may remove their eyeglasses and has to cover one of their eyes. The provider then asks if the patient can read the letters starting with the biggest letter.
The process will be repeated for the other eye. The provider can determine the patient’s eyesight based on the smallest letter the patient can read.
Further appropriate evaluation might be needed if the provider determines that the patient suffers from visual problems.
4. Billing Guidelines
As defined by CPT 99173, this screening test can only use graduated visual acuity stimuli like the Snellen chart to quantitatively estimate the visual acuity of the patient’s eyes. You can report other services for this test, but they must be billed separately.
Bill CPT code 99173 as a screening test and not as part of a diagnostic examination.
You can not report the 99173 CPT code in combination with;
- CPT 99177;
- CPT 99174; or
- CPT 99172.
CPT 99173 was initially created for testing visual acuity by pediatricians. Most pediatricians perform this procedure with CPT 99382, CPT 99382, CPT 99383, or CPT 99393 because AAP (American Academy of Pediatrics) recommends children’s visual acuity be screened by the age of four.
Some payers do not pay for CPT 99173, but you should still report it as a provided service. Especially Medicaid payers insist that it needs to be reported, and by billing this procedure, you ensure that you’ll be reimbursed by the payers that do cover it.
4.1 Does CPT Code 99173 Need A Modifier?
CPT does not require that CPT code 99173 needs to e billed with a modifier. But you should include modifier 25 in the claim because some payers have software systems that screen for modifier 25. In those cases, your claim might be denied automatically.